UCLA Radiological Sciences Proceedings

We report a case of primary pulmonary anaplastic lymphoma kinase-positive anaplastic large cell lymphoma in a 38-year-old woman with a smoking and vaping history. The patient presented with hypoxemia and a history of shortness of breath, cough, and intermittent fevers. Initial imaging and pleural fluid studies suggested possible empyema. Despite being given antibiotics, her respiratory status continued to deteriorate and she was put on extracorporeal membrane oxygenation. Repeat imaging showed increased size of intrathoracic lymph nodes and perilymphatic pulmonary nodules. IV steroids were initiated after bronchoalveolar lavage revealed lipophages suggestive of e-cigarette, or vaping, product use-associated lung injury. A laboratory workup revealed no signs of rheumatologic disease, and negative cultures ruled out a bacterial or fungal cause of the disease. Because of these laboratory results and because the patient did not show clinical signs of improvement, a biopsy of the left lower lobe lymph node was performed. The patient was diagnosed with anaplastic lymphoma kinase-positive anaplastic large cell lymphoma based on the results of the biopsy. This case highlights the importance of suspecting pulmonary lymphoma in patients with a history of B-symptoms and compatible imaging findings, despite its rarity.